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The Wake Forest Baptist Approach Blood and Marrow and Stem Cell Transplantation The Blood and Marrow Transplant (BMT) Program has achieved national renown since opening in 1990. It is the most active adult BMT Program in North Carolina. The complex transplantation procedure uses stem cells isolated in marrow and blood, either from a compatible donor (related or unrelated) or the patient’s own bone marrow. In addition to the use of transplantation for the treatment of acute and chronic leukemias, we are utilizing transplantation as an important means of treating non-Hodgkin’s lymphoma, Hodgkin’s disease, multiple myeloma, and other forms of cancer. In addition, our Program is the second largest Collection Center in the United States for the National Marrow Donor Program. Members of the Transplant Program have been active participants in clinical trials sponsored by the National Heart, Lung and Blood Institute, as well as clinical trials through the Cancer and Leukemia Group B (CALGB), a national cooperative group for clinical trials research supported by the National Cancer Institute. Leukemia and Lymphomas Our Leukemia Program, which began in 1986, is widely recognized for excellence in patient care, teaching and clinical research. As one of the largest adult leukemia services in the Southeast, we are active in national research studies. Active collaboration between basic science laboratory research faculty and our own clinical researchers ensures that patients are offered cutting edge therapies. Among the research studies currently underway is a clinical trial evaluating the use of arsenic trioxide as part of a front line therapy for patients with acute promyelocytic leukemia (APL), a subtype that accounts for approximately 10 percent of all acute myeloid leukemia.  This research study is sponsored by Cancer and Leukemia Group B (CALGB), one of three major adult national cancer research groups. In addition to access to the latest treatments, some of the multidisciplinary services offered for our leukemia patients are nutritional consults, recreational therapy, pastoral care services and the Cancer Patient Support Program. Additionally, our oncology staff works with patients and families to identify support and resources in their home communities. Lymphomas, including Hodgkin’s Disease and the array of non-Hodgkin’s lymphomas, represent a growing area of clinical interest at the Comprehensive Cancer Center. Treatment ranges from standard “treatment guideline” protocols to local and national research trials investigating cutting edge therapies. One particular area of emphasis is dose-intensive therapy followed by either bone marrow or peripheral stem cell transplantation.   Hodgkin’s lymphoma Lymphatic system Lymphoma, malignant - CT scan Hodgkin's disease, liver involvement Immune system structures   Definition: Hodgkin's lymphoma is a cancer of lymph tissue found in the lymph nodes, spleen, liver, bone marrow, and other sites. Alternative Names: Lymphoma - Hodgkin's; Hodgkin's disease; Cancer - Hodgkin's lymphoma Causes, incidence, and risk factors: The first sign of this cancer is often an enlarged lymph node which appears without a known cause. The disease can spread to nearby lymph nodes. Later it may spread to the spleen, liver, bone marrow, or other organs. The cause is not known. Hodgkin's lymphoma is most common among people ages 15 - 35 and 50 - 70. Infection with the Epstein-Barr virus (EBV) is thought to contribute to most cases. Symptoms: Fatigue Fever and chills Itching Loss of appetite Night sweats Painless swelling of the lymph nodes in the neck, armpits, or groin (swollen glands) Weight loss Other symptoms that may occur with this disease: Clubbing of the fingers or toes Excessive sweating Flank pain Hair loss Neck pain Pain in the affected areas after drinking alcohol Skin blushing or flushing Splenomegaly Signs and tests: The disease may be diagnosed after: Biopsy of suspected tissue Bone marrow biopsy Lymph node biopsy Detection of Reed-Sternberg (Hodgkin's lymphoma) cells by biopsy from any site A staging evaluation (tumor staging) may be done to determine how far the disease has spread. The following procedures may be done: Blood chemistry tests Bone marrow biopsy CT scans of the chest, abdomen, and pelvis PET scan Physical examination In some cases, abdominal surgery to take a piece of the liver and remove the spleen may be needed. However, because the other tests are now so good at detecting the spread of Hodgkin's lymphoma, this surgery is usually unnecessary. Hodgkin's lymphoma may change the results of the following tests: Angiotensin converting enzyme (ACE) levels Blood differential Bone marrow aspiration Cryoglobulins Ferritin Gallium scan Lymphocyte count Treatment: Treatment primarily depends on the following: The type of Hodgkin's lymphoma (most people have classic Hodgkin's) The stage (where the disease is found) Whether the tumor is more than 4 inches (10 cm) wide The patient's age and other medical issues Other factors, including weight loss, night sweats, and fever A staging evaluation is necessary to determine the treatment plan. Stage I indicates one lymph node region is involved (for example, the right neck). Stage II indicates involvement of two lymph node areas on the same side of the diaphragm (for example, both sides of the neck). Stage III indicates lymph node involvement on both sides of the diaphragm (for example, groin and armpit). Stage IV involves the spread of cancer outside the lymph nodes (for example, to bone marrow, lungs, or liver). Treatment varies with the stage of the disease. The best treatment for an individual patient depends on many factors, and should be discussed with a doctor who has experience treating this disease. Stages I and II (limited disease) can be treated with local radiation therapy, chemotherapy, or a combination of both. Stages III and IV (extensive disease) are treated with chemotherapy alone or a combination of radiation therapy and chemotherapy. Support Groups: You can often ease the stress of illness by joining a support group of people who share common experiences and problems. See cancer - support group. Expectations (prognosis): With the right treatment, more than 80% of people with stage I or II Hodgkin's lymphoma survive for at least 10 years. If the disease has spread, the treatment is more intense and the 5-year survival rate is about 60%. Complications: Inability to have children (infertility) Liver failure Lung problems Other cancers Side effects of radiation and chemotherapy Chemotherapy can cause low blood cell counts, which can lead to an increased risk of bleeding, infection, and anemia. To minimize bleeding, apply ice and pressure to any external bleeding. Use a soft toothbrush and electric razor for personal hygiene. Infection should always be taken seriously during cancer treatment. Contact your doctor immediately if you develop fever or other signs of infection. Planning daily activities with scheduled rest periods may help prevent fatigue associated with anemia. Calling your health care provider: Call your health care provider if: You have symptoms of Hodgkin's lymphoma You are being treated for Hodgkin's lymphoma and you experience side effects of radiation and chemotherapy, including nausea, loss of appetite, vomiting, diarrhea, fever, or bleeding References: Connors JM. Hodgkin's lymphoma. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 197. National Cancer Institute. Adult Hodgkin lymphoma treatment (PDQ). 2009. Accessed February 25, 2009.

Review Date:3/2/2009 Reviewed By:David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; and Yi-Bin Chen, MD, Leukemia/Bone Marrow Transplant Program, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.